stroke

Question 1

features of ACA stroke?

Answer 1

Contralateral hemiparesis and sensory loss, lower extremity > upper

Question 2

features of MCA stroke?

Answer 2

Contralateral hemiparesis and sensory loss, upper extremity > lower
Contralateral homonymous hemianopia
Aphasia

Question 3

features of PCA stroke?

Answer 3

Contralateral homonymous hemianopia with macular sparing
Visual agnosia

Question 4

features of weber’s syndrome (branches of PCA that supply midbrain)?

Answer 4

Ipsilateral CN III palsy
Contralateral weakness of upper and lower extremity

Question 5

features of posterior inferior cerebellar artery (aka lateral medullar + Wallenberg)?

Answer 5

Ipsilateral: facial pain and temperature loss
Contralateral: limb/torso pain and temperature loss
Ataxia, nystagmus

Question 6

features of anterior inferior cerebellar artery (aka lateral pontine) stroke?

Answer 6

Contralateral: limb/torso pain and temperature loss
Ataxia, nystagmus
Ipsilateral: facial paralysis and deafness

Question 7

features of ophthalmic/retinal artery stroke?

Answer 7

Amaurosis fugax

Question 8

features of basilar artery stroke?

Answer 8

‘Locked-in’ syndrome

Question 9

features of lacunar stroke?

Answer 9

present with either isolated hemiparesis, hemisensory loss or hemiparesis with limb ataxia
strong association with hypertension
common sites include the basal ganglia, thalamus and internal capsule

Question 10

what are the 2 types of stroke?

Answer 10

ischaemic

haemorrhagic

Question 11

RF for ishacmeic stroke?

Answer 11

General risk factors for cardiovascular disease
age
hypertension
smoking
hyperlipidaemia
diabetes mellitus

Risk factors for cardioembolism
atrial fibrillation

Question 12

RF for hemorrhagic stroke?

Answer 12

Risk factors
age
hypertension
arteriovenous malformation
anticoagulation therapy

Question 13

what are TACI?

Answer 13

involves middle and anterior cerebral arteries

all 3 of the below criteria are present:
1. unilateral hemiparesis and/or hemisensory loss of the face, arm & leg
2. homonymous hemianopia
3. higher cognitive dysfunction e.g. dysphasia

Question 14

what are PACI stroke?

Answer 14

involves smaller arteries of anterior circulation e.g. upper or lower division of middle cerebral artery

2 of the below criteria are present:
1. unilateral hemiparesis and/or hemisensory loss of the face, arm & leg
2. homonymous hemianopia
3. higher cognitive dysfunction e.g. dysphasia

Question 15

what are lacunar infarcts?

Answer 15

involves perforating arteries around the internal capsule, thalamus and basal ganglia

presents with 1 of the following:
1. unilateral weakness (and/or sensory deficit) of face and arm, arm and leg or all three.
2. pure sensory stroke.
3. ataxic hemiparesis

Question 16

what are POCI?

Answer 16

involves vertebrobasilar arteries

presents with 1 of the following:
1. cerebellar or brainstem syndromes
2. loss of consciousness
3. isolated homonymous hemianopia

Question 17

features of haemorrhage stroke?

Answer 17

decrease in the level of consciousness
headache
nausea and vomiting
seizures

Question 18

what are the IX done?

Answer 18

non contrast CT
maybe MRI

Question 19

who gets thrombolysis for ischameic stroke?

Answer 19

patients present with 4.5 hours of onset of stroke symptoms
the patient has not had a previous intracranial haemorrhage, uncontrolled hypertension, pregnant etc

Question 20

what is the immediate management for ischameic stroke?

Answer 20

Once haemorrhagic stroke has been excluded patients should be given aspirin 300mg as soon as possible and antiplatelet therapy should be continued.

Question 21

what is mx of TIA?

Answer 21

give aspirin 300 mg immediately, unless contraindicated e.g. the patient has a bleeding disorder or is taking an anticoagulant (needs immediate admission for imaging to exclude a haemorrhage)

Question 22

what is mx of hemorrhagic stroke?

Answer 22

Anticoagulants (e.g. warfarin) and antithrombotic medications (e.g. clopidogrel) should be stopped to minimise further bleeding. If a patient is anticoagulated this should be reversed as quickly as possible.

Question 23

how do stroke appear on CT?

Answer 23

acute ischaemic strokes:
- may show areas of low density in the grey and white matter of the territory. These changes may take time to develop
- other signs include the ‘hyperdense artery’ sign corresponding with the responsible arterial clot - this tends to visible immediately

acute haemorrhagic strokes:
- typically show areas of hyperdense material (blood) surrounded by low density (oedema)

Question 24

what needs to happen before thrombolysis can be performed?

Answer 24

Blood pressure should be lowered to 185/110 mmHg before thrombolysis.

Question 25

what is secondary prevention for stroke?

Answer 25

clopidogrel
aspirin is recommended after an ischaemic stroke only if clopidogrel is contraindicated or not tolerated